Ultrasonic cartilage thickness measurement is accurate, reproducible, and reliable-validation study using contrast-enhanced micro-CT.

Steppacher, Simon Damian; Hanke, Markus Simon; Zurmühle, Corinne Andrea; Haefeli, Pascal Cyrill; Klenke, Frank Michael; Tannast, Moritz (2019). Ultrasonic cartilage thickness measurement is accurate, reproducible, and reliable-validation study using contrast-enhanced micro-CT. Journal of orthopaedic surgery and research, 14(1), p. 67. BioMed Central 10.1186/s13018-019-1099-8

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BACKGROUND Ultrasonography is a fast and patient-friendly modality to assess cartilage thickness. However, inconsistent results regarding accuracy have been reported. Therefore, we asked what are (1) the accuracy, (2) reproducibility, and (3) reliability of ultrasonographic cartilage thickness measurement using contrast-enhanced micro-CT for validation? METHODS A series of 50 cartilage-bone plugs were harvested from fresh bovine and porcine joints. Ultrasonic cartilage thickness was determined using an A-mode, 20-MHz hand-held ultrasonic probe with native (1580 m/s) and adjusted speed of sound (1696 m/s). All measurements were performed by two observers at two different occasions. Angle of insonation was controlled by tilting the device and recording minimal thickness. Retrieval of exact location for measurement was facilitated by aligning the circular design of both cartilage-bone plug and ultrasonic device. There was no soft tissue interference between cartilage surface and ultrasonic probe. Ground truth measurement was performed using micro-CT with iodine contrast agent and a voxel size of 16 μm. The mean cartilage thickness was 1.383 ± 0.402 mm (range, 0.588-2.460 mm). RESULTS Mean accuracy was 0.074 ± 0.061 mm (0.002-0.256 mm) for native and 0.093 ± 0.098 mm (0.000-0.401 mm) for adjusted speed of sound. Bland-Altman analysis showed no systematic error. High correlation was found for native and adjusted speed of sound with contrast-enhanced micro-CT (both r = 0.973; p < 0.001). A perfect agreement for reproducibility (intraclass correlation coefficient [ICC] 0.992 and 0.994) and reliability (ICC 0.993, 95% confidence interval 0.990-0.995) was found. CONCLUSIONS Ultrasonic cartilage thickness measurement could be shown to be highly accurate, reliable, and reproducible. The A-mode ultrasonic cartilage thickness measurement is a fast and patient-friendly modality which can detect early joint degeneration and facilitate decision making in joint preserving surgery.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery

UniBE Contributor:

Steppacher, Simon Damian; Hanke, Markus; Zurmühle, Corinne Andrea; Haefeli, Pascal; Klenke, Frank M. and Tannast, Moritz


600 Technology > 610 Medicine & health




BioMed Central




Kathrin Aeschlimann

Date Deposited:

31 Oct 2019 10:30

Last Modified:

03 Nov 2019 02:41

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Accuracy Cartilage thickness Micro-CT Ultrasonography Validation





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